Saturday, March 28, 2009

Surgical methods to remove venereal warts

The initial treatment of venereal warts is usually medical. However, sometimes the wart may be bleeding or may be too large and surgery is another option of treating venereal warts. Surgery is also an ideal method for pregnant females if do not want to have the baby exposed to venereal warts. Today, there are several decent surgical options for removing venereal warts. These options include the following:

Cryotherapy
(liquid nitrogen). In this method, liquid nitrogen is applied with a Q-tip on the wart. The initial treatment is not painful but as the wart starts to breakdown, the skin does become sensitive. The skin will blister and the wart will slowly slough off. One goes to a skin clinic where the physician applied liquid nitrogen 1-2 times a week. One needs long-term treatment which usually averages anywhere from 8-16 weeks. While the treatment is effective, it does tend to hurt in the later stages.

Electrocautery-
this is just another fancy name for a heated electrical current to be applied to the wart. It is definitely painful. The treatment is effective but most people cannot tolerate the pain. The physician may apply a cooling gel o r a local anesthetic, but electrical current is still painful. It usually feels like a hot needle which is plunged into your skin (teach you not to fool around without a condom next time)

Surgery:
Sometimes the wart may just be hanging off a stalk and can easily be excised. Most of these small warts can be removed with the use of local anesthesia. However, some warts located near the vagina or anus can be difficult to remove with only local anesthesia- the pain can be significant.

Laser: Today lasers are used of everything except cooking food. The laser generates an intense beam of light that generates energy. The laser can cut as well as kill the wart cells. Large warts requires multiple sessions. While laser is good, it hurts like hell and is very expensive. It is usually not the first method of choice. Most physicians reserve the laser for large warts that have failed other treatments.

Once a wart has been treated, there is no guarantee that it will not come back. All these treatments do not actually kill the virus, just the wart cells.

Aldara to Treat Venereal Warts part 2

Aldara cream should not be used by individuals who have allergies to any of the components in the cream.

During the time, Aldara is applied, sexual activity of all type is not recommended, and this means no oral, anal, or vaginal sex. For a female, great care should be exercised when the cream is applied near the vagina. It should not be applied anywhere on the inside of the vagina otherwise considerable pain and swelling can occur.

Males who are uncircumcised and have warts under the foreskin should retract the foreskin and clean the area on a daily basis

Aldara is not a cure for genital warts and new warts can occur after and during therapy

Because aldara may weaken condoms and vaginal diaphragms, it is recommended that these devices be used as a method of birth control. Because the effects of Aldara on the fetus are unknown, pregnant females and those who are breast feeding should avoid using the drug.

Aldara is only recommended for individuals over the age of 12

Aldara is not a cheap drug. It is not covered Medicare or any medical insurance plan. A 12 pack costs anywhere from $125-$175.

For those who do not have that kind of money, perhaps liquid nitrogen (cryotherapy) may be an alternative- cheap but a wee bit painful especially if the wart is large.

Aldara to Treat Venereal Warts

Aldara is the brand name for imiquimod, which is an immunomodulator type of drug. It is available as a 5% cream and used to treat a variety of skin conditions including venereal warts. For some unknown reason, it only works on genital warts and not the common warts.

For venereal warts, the area should first be cleaned and dried. The surrounding skin should be protected by some Vaseline or moisturizing cream. Aldara cream can be applied on the wart with a Q-tip. The cream is best applied at night and allowed to remain for 6-10 hours. In the morning, the area should be thoroughly rinsed. Almost all individual do develop some type of skin reaction that varies from moderate to severe.

The skin may show an intense redness, weeping or peeling after the first few applications. In some individuals, aldara may also cause general fatigue, fever, nausea and muscle pain. For those who develop serious skin flare ups, use of aldara should be discounted.

After application of aldara cream, one should avoid the sun because of the increased sunburn sensitivity. Suntan should be avoided until the skin has completely healed and aldara has been discontinued.

The cream is usually applied 3 times a week (e.g., Monday, Wednesday, and Friday) and most individuals begin to see a clearing of the warts in 8-12 weeks.

Wednesday, March 25, 2009

Treatment of warts with podophyllotoxin

Many physicians use the substance podophyllotoxin to treat venereal warts. Podophyllin is actually a plant substance extracted from the plant podophyllum peltatum. For decades, it has been used as a medicinal compound by the North American Native Indians.

Podophyllotoxin actually prevents the wart cells from multiplying and dividing. Eventually all the wart cells die and the wart disappear.
Today Podophyllin is available only with a prescription and used as a cream or solution. It is not recommended to be used internally or for warts that are larger than a quarter.

In most cases, physicians apply the Podophyllin themselves and are reluctant to give out a prescription because the chemical is toxic. Once the skin is washed and completely dry, one should apply a cream on the normal skin. This is to prevent the Podophyllin from irritating normal skin. Then using a Q-tip the Podophyllin is applied and the wart is covered. The wart must be dry before applying the chemical. Podophyllin is applied twice a day for 3-4 consecutive days. In most cases, the treatment has to be repeated for several weeks.

In general, Podophyllin should not be applied for more than 5 weeks. Within this time period, most warts are gone. It is extremely important to make sure that the Podophyllin does not come into contact with the eyes, nose, mouth or healthy skin, inside the vagina, rectum or the urethra. If this happens, flush with water for 15-20 minutes. If inadvertent contact has been made with healthy skin, apply Vaseline or zinc ointment. Wash hands after each application and discard the Q-tip.

The first application of Podophyllin on the wart is painless but the subsequent applications do sting. This is because the wart is dying and the raw surface is exposed. Itching, pain and redness are common complaints. These effects are transient and can be reduced by applying some over the counter hydrocortisone.

Women who are pregnant or breast-feeding should not be treated with Podophyllin, as the safety of this agent has not been demonstrated on the fetus.

Podophyllin is a great drug for warts as long as one can tolerate the subsequent pain and discomfort.

Sunday, March 22, 2009

Treatment of warts with trichloroacetic acid

The first thing that everyone who has warts needs to understand is that more than 1/3rd of all cases of genital warts disappear spontaneously without doing anything. For the majority of individuals who have warts that are not bothersome, the best thing to do is Nothing- and that means keep away from health care professionals.

For individuals who have warts which are causing symptoms like burning, itching, bleeding or pain, then one can seek treatment. The majority of other individuals who seek treatment have no symptoms but are bothered by appearance of warts on the genitals. The second thing that all people who have warts should know is that the HPV is never completely destroyed with treatment. The virus has an ability to hide and genital warts can recur after treatment.

The treatment options are as follows:

Trichloroacetic acid (TCA) or bichloroacetic acid can be used to treat venereal warts. The acid works by destroying the top protein layer on the warts and slowly reduces growth. Trichloroacetic acid is only supposed to be applied once a week. To prevent skin irritation, it has to be applied only on the wart.

The health care professional will apply some Vaseline or a thick cream around the normal skin before applying the TCA to the warts.

TCA works about 60%-80% of the time and the effects are not immediate. In most cases, warts take anywhere from 6-10 weeks to disappear. TCA is most effective for the very small warts (< 3 mm).

When TCA is initially applied on the wart, it does sting for a few minutes. Individuals who have sensitive skin should be forewarned, TCA can cause moderate pain, severe irritation and blister formation it if gets on normal skin. Individuals who have large warts > 5 mm, should not apply TCA. TCA can be quite painful when more of it is applied to skin.

Because of the potential for complications, TCA applications for warts is only performed by health care professionals. Home use of high strength TCA is not recommended.

Diagnosis of Venereal Warts

When the warts are large, they are easy to diagnose. Sometimes, however, warts can be small and may be mistaken for a skin tag or scar. Some physicians do apply acetic acid (vinegar like solution) to the genitals. This immediately whitens the warts and one can view the warty like structure under a microscope. It is extremely rare for a wart to be cut out for diagnosis.

For women, when a wart is identified, several other tests are also important. Because Warts are associated with the human Papilloma virus and known to cause cervical cancer, women need a pap test.

The Pap test is a fancy word for taking scrapings (swabs) from the cervix and looking at them underneath a microscope. Pap tests are generally recommended for all women within 3 years after having started sex or at the age of 21-whichever comes first. After the age of 30, pap tests are infrequent if one has had all previous tests which were normal.

Women who have venereal warts need to have a pap tests every 3-6 months depending on the severity of changes in the cervix.

Thursday, March 19, 2009

Can you get herpes from a toilet or a public washroom?

Well, anything is possible but it is very unlikely. The majority of viruses do not survive outside the body for more than a few seconds. In damp moist environments, bacteria may grow but viruses generally perish. All sexually transmitted disorders like herpes, gonorrhea, Chlamydia etc are transmitted via sexual intercourse; break in the skin or coming in contact with infected fluids like blood.

So as long as you are not having unprotected sex or drinking blood from an infected individual in the bathroom, you should be okay.

Even if an individual with active herpes uses a bathroom or the toilet, it is very unlikely that the virus will come out of the body system and remain viable on inanimate objects. In any case, always wash your hands, practice good hygiene, use a condom when having sex with an unknown partners, and play safe

Thursday, March 12, 2009

Sex is Fun until one gets Gonorrhea Part 9

Follow-up

It is essential that the entire course of antibiotics be completed. Once the antibiotic course has been finished, it is important that the individual be retested to make sure that the infection has been treated. A major part of treatment for gonorrhea involves treatment of the partner. All sexual partners must be notified and tested for infection to ensure that the infection is not re-transmitted in a cycle. With a wide acceptance of an open sexual life style with multiple partners, it is highly recommended that the individual also get tested for other sexually transmitted disease like Chlamydia, syphilis and human immunodeficiency virus (HIV).

Prevention

Prevention of gonorrhea

- Use of latex condoms during sexual intercourse
- Avoidance of sexual intercourse with high risk partners
- Get partners tested for STDs prior to any sexual activity.

Outlook

After the antibiotic treatment is completed, more than 95-99% of first time episodes of gonorrhea are cured. A few individuals may not respond and may require alternative drugs.

Consultations

In cases of suspected rape or child abuse, it is mandatory to discuss the case with other specialists such as social workers, psychiatrists and pediatricians. It is important to obtain and stores the samples in the presence of some legal authority. Every detail about the case must be documented and all physical findings must be recorded/photographed for possible medico-legal reasons. All physicians are required to report the case to child protective services if there is any hint of abuse.

Sex is Fun until one gets Gonorrhea Part 8


Treatment


There is no room for self care treatment at home in the case of gonorrhea. There are no herbs or nutritional supplements to treat this condition.

Various antibiotics are used to treat gonorrhea. In the past decade the fluoroquinolones [examples are Cipro, and Levaquin] were widely used in the treatment of gonorrheal infection.

Because of increasing resistance of many strains of N. gonorrhea to the fluoroquinolones drugs, the CDC now recommends that only one class of antibiotics should be used to treat the infection. Today, the cephalosporins are widely used to treat gonorrhea. The present day treatment of gonorrhea requires a single dose injection of an antibiotic (ceftriaxone or a single-dose pill such as Cipro).

The majority of men are treated by a single injection of antibiotic and are discharged home. Admission to the hospital is done if there is evidence of spread of infection to other parts of the body (such as brain, joint, heart). If the patient shows evidence of infection in the blood or appears sick, admission to the hospital may be required for intravenous antibiotics.

For females with gonorrhea, the treatment is more complex and may more often requires admission to the hospital because the complications and the non compliance rates are higher than males. Because, the majority of these females are seen in clinics and with rising health care costs and physician reluctance to admit these patients, the majority are discharged home, like their male counterparts.

Most females should be informed about PID and future difficulties with pregnancy. Even though most females are given follow up appointments, less than 10% show up for future appointments.

Sex is Fun until one gets Gonorrhea Part 7

Diagnosis

Diagnosis is easily confirmed by staining or culturing the discharge from the penis or vagina. Today commercial kits are available which can rapidly identify the presence of gonorrhea. All cases of gonorrhea must be reported to the publish health system. Because there are other organisms which are also sexually transmitted, it is recommended that a test for syphilis and Chlamydia be done at the same time.

For those individuals who complain of a sore throat and rectal pain, swabs from these areas should be obtained for culture.

Today there are nuclei acid probes which can identify gonorrhea with 100% sensitivity. For individuals with no secretions from the genitals, these nuclear probes are useful as they can detect gonorrhea on the minutest amount of secretion.

Some individuals with gonorrhea also have the infection in the blood and may develop arthritis or infection of the heart. Any young male who is sexually active and presents with swelling and pain in the joint should always be suspected of gonorrhea. Blood or fluid from the joint can be cultured and the organism can be identified using the various nuclear probes.

Sex is Fun until one gets Gonorrhea Part 6

Males

The majority of men will show some symptoms in a few days after acquiring the infection. Pain or burring during urination is the most common complaint. At least 50% of men will also have a penile discharge. A few men will also complain of mild tenderness along the penile shaft and testicles. Other symptoms include:

- urethral discharge (drip from the tip of the penis)
- Dysuria (painful urination)
- Proctitis (anal gland infection associated with pain
- Pharyngitis (sore throat from oral sex)

With oral sex becoming an integral part of a sexual relationship, there is also an increasing incidence of gonococcal related infections of the throat. These individuals complain of sore throat after a sexual encounter and may have other features of a gonorrheal infection.

For those who engage in anal sex, gonorrhea is fast becoming a major source of rectal pain and infection. Many men also develop infection of the prostate after having performed anal intercourse.

Those males, who engage in routine anal sex with other men, generally tend to acquire a resistant form of gonorrhea. This resistant type of gonorrhea is gradually becoming more difficult to treat with the standard group of antibiotics available today.

Children


In newborns, vaginal transmission can cause conjunctivitis (infection of eye), known as ophthalmia neonatorum, and if left untreated can lead to blindness. In a young child with vaginal irritation or discharge, sexual molestation should always be suspected.

Sex is Fun until one gets Gonorrhea Part 5

Symptoms

Females


Once a female gets infected, the symptoms are not immediate but gradually appear within 2-10 days. Some individuals, esp. women, generally do not tend to show any symptoms until 2-3 weeks after acquiring the infection. However, there are some females (at least 30%) who may not show any symptoms.

Gonorrhea is the second most common cause of pelvic inflammatory disease that usually leads to infertility. In the majority of cases, it leads to irritation of the cervix, increased urgency to urinate and the need to urinate more frequently. A significant number of women also complain of vaginal itching, burring and a foul smelling vaginal discharge.

Oral sex with an infected partner can result in pharyngitis, and, similarly, anal infection can arise from anal sex or local spread from a vaginal source. PID, especially if recurrent, is a major cause of future infertility and is also associated with infection of the ovary (tuboovarian abscess).

In some cases, the infection is so rampant that it can cause rupture of the fallopian tubes, leading to rapid spread of infection in the pelvis and abdomen and frequently death is the end result. For those females who have had recurrent PID, the chances of developing an ectopic pregnancy and infertility are significantly higher compared to healthy females without PID. The typical symptoms of gonorrhea in a female include:

- Dysuria (painful urination)
- Vaginal/cervical discharge
- Abnormal cervical/vaginal bleeding (spotting)
- Dyspareunia (painful intercourse)
- Cervical pain during examination
- Proctitis (anal gland infection after anal intercourse)
- Pharyngitis (sore throat from oral sex)
- Chronic lower abdominal and pelvic pain
- Lower back pain (radiating pain from the pelvis)

Sex is Fun until one gets Gonorrhea Part 4

Morbidity of untreated Gonorrhea

Gonorrhea unfortunately does not simply go away.

The worst part of acquiring this infection is that the partner also needs treatment. For those who do not get proper treatment, the likelihood of the disease spreading are high.

In males the infection can spread to other parts of the genitalia (testis and epididymitis) and produce sterility.

In females, the infection can cause severe scarring and adhesions of the uterine tubes and this is one major reason why many females are not able to conceive later on in life. The infection can also spread to the liver, joints, brain and the heart.

Sex is Fun until one gets Gonorrhea Part 3

Who is at Risk for gonorrhea?

Because of the difference in the urogenital anatomy between males and females (short urethra), the risk of transmission of N gonorrhea from an infected woman to the urethra of her male partner is approximately 20% per episode of vaginal intercourse and rises to 60-80% after 4 or more exposures.

In contrast, the risk of male-to-female transmission approximates 50-70% per contact, with little evidence of increased risk with more sexual exposures.
Persons who have unprotected intercourse with new partners frequently enough to sustain the infection are defined as core transmitters.

Gonorrhea is more common in some people and the highest infection rates have been reported in

- young adults and teenagers
- inner city males and females
- blacks and Hispanics
- IV drug users
- Those who have sex with an infected partner
- those who have multiple sex partners
- Poor and minorities with no access to education/health care
- Those who do not use condoms
- Those with a prior history of STD
- Those who use IV drugs

The major reason why individuals acquire gonorrhea is by having unprotected sexual intercourse with an infected partner. Men have a 20% chance of getting the infection by having sexual relations with a woman infected with gonorrhea.

However, women have a 50% chance of getting the infection by having sexual relations with a man infected with gonorrhea. The reason for this is that the females have a very short urethra which rapidly colonized the harmful bacteria. When an infected female gets pregnant, there is a good chance that the baby will be infected during vaginal birth.

Sex is Fun until one gets Gonorrhea Part 2

Estimates of total cases in the US indicate that there are about 700,000 cases per year. This number is significantly lower than the actual caseload because many physicians fail to report the infection. Gonorrhea has also been encountered in sexually abused children. There are also a significant number of sexually active young females who are asymptomatic and have gonorrhea.

Within the United States carriage rates are highly dependent on the geographical area, urban versus rural location, age, racial and ethnic group, and sexual preferences. The incidence of gonorrhea is highest in the South and Eastern USA, whereas the lowest rates are in the Midwest and Northeastern USA. Data from the CDC reveal that the rates of infection vary from about 250 per 100,000 in Mississippi to 7.5 per 100,000 in Idaho.

The CDC has started a campaign to decrease the incidence to 19 cases per 100,000 by the year 2010. The only states currently exceeding this number are North Dakota, Maine, Vermont, Wyoming, New Hampshire, Montana, and Idaho.

Rates of gonorrhea are difficult to obtain from Asia, South America, and Africa since data are not complete/recorded and many patients do not have access to health care. In most of Europe, the disease rates are similar to North America.

Sex is Fun until one gets Gonorrhea Part 1

Gonorrhea is one of the most common and oldest known sexually transmitted disease (STD). It can cause urethritis (infection of urethra), cervicitis (infection of cervix), epididymitis, pharyngitis (sore throat), proctitis (rectal inflammation) and pelvic inflammatory disease (PID).

If not treated, the disease can spread throughout the body. However, because the genital symptoms are so unpleasant most individuals seek help before the disease has a chance of spreading.

Gonorrhea is the second most common cause of PID in and caused by a bacteria known as Neisseria gonorrhea. The infection is acquired via sexual intercourse (both vaginal and anal). Recent data show that the disorder is increasingly being transmitted to the throat via oral sex. It can also be transmitted from the mother's genital tract to the newborn during birth to cause ophthalmia neonatorum (eye infection) and systemic neonatal infection.

Gonorrhea is a reportable infectious disease in the United States (meaning that all doctors have to report the patient to a government agency that documents such infections). Gonorrhea had declined in the 80s and 90s, but there has been a resurgence of the infection in the last 2 decades.